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Gout: signs and treatment, nutrition and causes
Gout ("illness of kings") is often associated with the formation of a bump on the big toe. However, the disease is not limited to only one joint, gradually affecting the articular structures of the body and internal organs.
Understanding the process of occurrence of the disease and factors provoking it gives a chance to correct strayed metabolic processes, minimize painful exacerbations and, finally, avoid disability - so what is it?
Gout: what is the disease?
Gout is a pathology (failure, disruption) of metabolic processes associated with excessive formation or insufficient removal of uric acid from the body. There are 4 stages of gout formation:
- The accumulation of uric acid in the body, which is recorded by an increased level of its content in the blood.
- The formation of salt crystals in the joints.
- Aggression of immune cells against urate formations and inflammation of the damaged joint.
- Distant manifestations of gout, kidney damage, joint deformities.
Gout - especially age-related disease. Almost all older people from 65 years old show signs of this disease. And in children and young people gouty changes are recorded in exceptional cases.
More often men suffer from gout, usually ailment takes them by surprise after 40 years. This fact is due to the physiologically high content of uric acid in male blood. The risk of developing pathology in women increases significantly with the onset of menopause (50 years). A better understanding of what gout is will help the causes of this "royal" disease.
The presence of gout in a person is an indicator of irrational life (low physical activity, unhealthy diet). That is why gout has long been called the "disease of kings" because of their idle lifestyle.
The concentration of uric acid in the blood increases for the following reasons:
- Gastronomic addictions - overeating, fatty foods (fish / meat, smoked foods, pickles), alcohol abuse (including beer) and, as a result, obesity;
- Hypodynamia - lack of exercise on the body;
- Sharp weight loss due to illness, improper diet;
- Smoking (nicotine is actively incorporated into metabolic processes);
- Long-term microtrauma of the joints (tight shoes, overload on the foot);
- Hormonal disorders (in women, in the first place, menopause);
- Long-term reception of aspirin, diuretic.
However, not only external factors can provoke the formation of urate deposits. Gout often develops in the background:
- chronic kidney failure;
- kidney stones, gall bladder;
- diabetes ;
- severe allergic diseases (eczema, psoriasis, bronchial asthma );
- hypertension and high blood cholesterol;
- hereditary predisposition (gout in blood relatives in previous generations).
Signs and treatment of gout, photo
Signs of gout cannot be confused with another disease, so specific are its manifestations. The first symptoms appear in the joint area of the big toes (one or both). It is this joint of the thumb that gout chooses as the first target.
Gouty arthritis is not symptomatic until the provocative moment: tight shoes, a feast with overeating and drinking alcohol.
Characteristic symptoms for a gout attack:
Suddenly at night there is pain in the joint. This is one of the most severe pain a person has ever experienced. Even strong and enduring people mark its unbearable intensity, which practically immobilizes the entire foot. The situation is aggravated by the absolute ineffectiveness of painkillers.
The affected joint swells up, spilled hyperemia appears. Often, body temperature rises to high numbers (39-40ºС).
The attack of gout lasts up to 4 days, and then disappear on its own, even without taking medication. Self-healing painful symptoms based on the inclusion in the fight against inflammation of phagocytes. Temporary relief, sometimes lasting several years, does not mean recovery.
Pathological changes affect the phalangeal joints of the fingers, the larger ankle and the wrist joint, often the knee. An increase in joint size and limited mobility does not disappear with the departure of an attack of gout.
For progressive gouty pathology, the symptoms are:
Painless bumps under the skin are a collection of urates. Characteristic localization: behind the ears, elbows, skin over the affected joint. Tofusa are prone to self-dissection, with a white cheesy mass emanating from the wound. A similar picture is observed after 5-6 years from the first attack of gout.
The accumulation of urate deposits in the joint leads to its persistent deformation (subluxation) and a significant restriction of mobility in it. With a protracted course of the disease, the patient cannot move without a cane.
The kidneys, as a "cleansing station" of the blood, accumulate urates in themselves, without ensuring their full-scale elimination from the body with urine. This process gradually forms sand / kidney stones.
Diagnosis of gout
If you suspect gout, you should contact a rheumatologist. The diagnosis is made taking into account:
- specific symptoms of the disease;
- visual examination (inflammation of the joint, detection of subcutaneous tophus);
- biochemical blood test (high level of urates);
- X-rays (damage to the articular surfaces and tophuses inside the articular sac, leading to a narrowing of the intra-articular gap, with severe damage - a symptom of a “piercer” - germination of the tophi in the bone tissue);
- punctures of the diseased joint (needle-like urate inclusions, non-detection of an infectious agent of inflammation, leukocytes up to 20x109 / l with exacerbation of gout);
- puncture of tophus (composition - urates).
The first treatment for gout is pain relief. Patients suffering from gout should know the list of measures that can reduce pain during exacerbation:
- Rest injured limb.
- Cold on painful hearth: wet towel, ice pack, bottle with cold water.
- NSAIDs (Ortofen, Voltaren, Naproxen, Diclofenac) in tablets or injections (injections increase the a / d somewhat, it is recommended to do in the morning).
When seeking medical help and sustaining pain, intra-articular steroids and intravenous injection of colchicine are possible.
How to treat gout and achieve stable remission will tell only a qualified doctor, based on the results of the diagnosis of a particular case. We consider general measures of therapy.
To prevent recurrence and the development of the disease, the following drugs are prescribed (treatment courses):
- NSAIDs - take with caution, irritate the gastrointestinal mucosa;
- Corticosteroid drugs - are appointed taking into account the immunosuppressive properties and leaching of calcium from the bones;
- Colchicine - normalizes the exchange of uric acid, adversely affects the composition of the blood and gastrointestinal tract;
- Vitamins P and C - contribute to the dissolution and output of urates;
- Uricodepressants (Allopurinol, Orotic acid) - reducing uric acid production;
- Uricosuretics (Benzbromanol, Ketazon, Probenecid) - remove uric acid from the body, are contraindicated in chronic renal failure, gastrointestinal diseases (especially liver).
With high blood levels of uric acid and low renal capacity (output with urine of less than 3.56 mmol / day), it is advisable to combine the use of uricosuretics and uricodepressants. Dose and duration of treatment for the treatment of gout are determined individually. Treatment courses are long (up to 1 year) with a break of 2 months.
Physiotherapy has a beneficial effect on the affected joint: ultraviolet irradiation (during exacerbation), medicinal phonophoresis, paraffin therapy, and ultrasound exposure (during remission).
Surgical treatment (arthroplasty, prosthetics) is indicated for significant joint deformity, significant immobilization. Often, surgical procedures are performed under local anesthesia using arthroscopy (endoscopic treatment).
Gout Treatment at Home
In the treatment of gout at home, you can use the following most effective for gout recipes: tincture of lilac or fir cones, decoction of bay leaf.
It is worth remembering:
- The use of medicinal raw materials is approved by the attending physician.
- Such recipes have their own contraindications. For example, bay leaf is strictly prohibited for pregnant women (provokes premature birth and bleeding), patients with ulcerative lesions of the gastrointestinal tract and diabetes, with constipation.
- Home remedies do not replace drug therapy prescribed by a doctor.
Food: menu for gout
Without nutritional correction, the effectiveness of drug therapy is significantly reduced. To normalize metabolic processes and prevent the development of exacerbations, you must follow a diet:
- with reduced fat intake,
- limiting sodium intake,
- with an emphasis on vegetable proteins and vitamins;
- excluding preservatives.
Diet for gout prohibits the use of foods:
- Salt (complete exclusion or daily intake of no more than 1/2 tsp).
- Cream cakes.
- Spices and spices (you can vinegar, bay leaf).
- Fatty meat / fish, smoked meats, by-products (especially aspic).
- Figs, raspberries, raisins and fresh grapes.
- Bean cultures.
- Chocolate, cocoa, strong brewed tea, coffee.
- Greens - spinach, cauliflower, sorrel, lettuce.
- Bread (white, rye), pasta.
- Vegetables (preferably fresh), fruits (citrus and cherry are especially useful).
- Milk, cottage cheese, kefir, butter.
- Bird, lean fish (recommended boiled 2-3 times in the weekly menu).
- Sugar without restrictions and honey (at a normal level of glucose in the blood).
- Juice, mineral water.
The use of warm mineral water or a glass of water with the addition of lemon juice will speed up the metabolism. Also, the exchange processes are normalized at the weekly discharge floor.
Read more: therapeutic diet table 6 for gout .
- Severe joint deformity, disability.
- Gouty kidney, acute / chronic insufficiency, stones.
- Hypertension, ischemia of the heart.
To avoid the appearance of gout will only help a healthy lifestyle (physical activity, the rejection of bad habits, proper nutrition). This "jaded" and often not taken seriously phrase protects the body from many diseases, including gout.
In order to stabilize the condition and eliminate complications, one should strictly observe the medical recommendations and strictly follow the diet prescribed for gout. Only then a long struggle with the disease will bring results.